体外聚焦微波刀治疗放射性直肠炎的临床观察及护理

放射性直肠炎多为盆腔或下腹部肿瘤放疗引起的并发症，主要表现为腹痛、腹泻、便血、里急后重，严重者可引起直肠阴道瘘，使原本遭受癌痛折磨的患者雪上加霜。为减轻患者的痛苦，降低放疗毒副反应，提高治疗效果，延长生存期，提高患者的生活质量，我院2005年11月～2008年3月采取体外聚焦微波刀治疗放射性直肠炎110例对比观察，疗效满意，现报道如下：     

放射性直肠炎的护理体会

<正>放射性直肠炎是腹腔、盆腔放射治疗过程中常见的并发症,尤其以宫颈癌患者治疗中更为多见。据报道[急性放射性直肠炎发生率为50%~75%,最早可在照射后2 d发生,早期可表现为大便次数增多,里急后重,晚期可出现便血,甚至合并直肠宫颈瘘或直肠阴道瘘,影响患者放射治疗的正常进行     

放射性直肠炎临床治疗方法的研究进展

放射性直肠炎是盆腔恶性肿瘤患者在接受放射治疗时或者在放疗后引起的直肠并发症,可表现为腹痛、腹泻、便血及粘液脓血便,严重者可出现肠出血、肠梗阻、肠穿孔及直肠阴道瘘。随着放疗技术的广泛应用,近年来放射性直肠炎的发生率有增高的趋势。目前的治疗方法主要有内科药物治疗、内镜治疗、外科手术、高压氧以及中药治疗等,但尚无统一的标准治疗方案。本文主要对放射性直肠炎临床治疗方法进行综述,探索有效可靠的治疗方案。     

姜炭在宫颈癌放射治疗所致的放射性直肠炎中的止血作用及机制研究

<正>放射性直肠炎是妇科肿瘤及其他盆腔、腹腔、腹膜后恶性肿瘤接受放射治疗后常见的急性和慢性并发症。急性期多在放射治疗后1²周,可见腹泻、里急后重、便血等症状;慢性放射性直肠炎是指由急性放射性直肠炎迁延而来或直接照射半年后引起间质纤维化,闭塞性血管内膜炎而引起局部组织缺血所致[1],多发生在放射治疗的6个月至数年,可出现便血,甚至合并直肠宫颈瘘或直肠阴道瘘,给患者生活造成很大痛苦与不便。它是盆腹部肿瘤放射治疗常见并发症之一,可造成永久性迁延不愈的严重放射性损伤[2]。而放射治疗是宫颈癌的主要治疗方法,5年生存率50%,随着放射剂量的增加,放射线可直接损害肠黏膜细胞而出现放射性直肠炎,给     

放射性直肠炎中医药研究新进展

放射性直肠炎（radiation enteritis，RE）是由于较大剂量放射线照射直肠所引起的肠道并发症，临床表现为腹泻、腹痛、便血和黏液脓血便，严重者可出现肠梗阻、肠穿孔及直肠阴道瘘。现代医学对放射性肠炎的常规治疗多采用对症、手术、营养支持等治疗，不良反应颇多，复发率高。探索中医中药对本病的影响受到关注，现介绍如下。     

谈肛门直肠瘘的非手术治疗和手术治疗法

肛门直肠瘘简称“肛瘘”。肛瘘多为肛管直肠周围脓肿，经切开或自行破溃后，因原发口继续感染化脓，或炎症反复刺激瘘道，使瘘管壁纤维化，变硬弯曲狭窄而使引流不畅，经久不愈所形成。主要症状是疮口反复淋漓不断地向外流脓或脓血，甚至有粪便流出或向肛管周围扩展，形成多个管道，或与邻近脏器相通，形成直肠阴道瘘、直肠膀胱瘘等。笔者经多年临床实践，对该病治疗积累了一定经验，今从非手术与手术治疗论述之，以与同道商榷。     

直肠癌老年女性患者术后并发直肠阴道瘘的多因素分析

目的:探讨直肠癌老年女性患者全系膜切除术后并发直肠阴道瘘的危险因素。方法:对36例行直肠全系膜切除术的老年女性直肠癌患者术后并发直肠阴道瘘的危险因素进行单因素检验和logistic回归分析。结果:全系膜切除术后直肠阴道瘘发生的主要因素是肿瘤位于直肠前侧壁(OR=2.413),使用双吻合器(OR=2.171),肿瘤距肛门位置10 cm(OR=1.833),肿瘤分期(OR=1.547),术前放疗(OR=1.233),绝经(OR=1.043)。结论:肿瘤位于直肠前侧壁、使用双吻合器、肿瘤距肛门位置10 cm、肿瘤分期、术前放疗及绝经是直肠阴道瘘的危险因素,临床医生应积极采取防治对策。     

1例转移性肝癌合并直肠阴道瘘的护理体会

直肠阴道瘘是直肠与阴道之间形成的异常通道，通常有大便不断自阴道溢出。根据瘘孔与肛门和阴道的距离分为低位或高位瘘孔，均表现为有大便自阴道溢出，严重时大便不能自控。多见于产伤、手术创伤、放射性创伤、肿瘤侵犯等原因引起。首先要确定是直肠阴道瘘还是直肠膀胱瘘，可用美蓝2ml＋生理盐水100ml作保留灌肠，通过阴检指套染蓝，证实为直肠阴道瘘。若为癌瘤引起的直肠阴道瘘患者需在肿瘤治愈后才能考虑手术。[第一段]     

32例食管癌放疗后食管瘘临床相关因素分析

目的：分析食管癌放疗后食管瘘形成因素,探讨减少放疗后食管瘘形成的措施。方法：对32例放疗后食管瘘形成病例予以回归性分析。结果：单因素分析表明：溃疡型病灶、营养状况差、病灶外侵者,肿瘤残留、联合化疗、单独较大高剂量体积的患者放疗后易形成食管瘘。多因素分析显示放疗后食管瘘形成的高危因素依次为：肿瘤大体类型、肿瘤外侵范围、是否联合化疗、高剂量体积、肿瘤残留、营养状况。结论：溃疡型、髓质型、肿瘤外侵范围广、联合化疗、单独高剂量体积较大、肿瘤残留、营养状况差与放疗后食管瘘形成关系密切,可采取相关措施减少放疗后食管瘘发生。     

结肠造瘘口粘膜淤紫2例分析

例1：男性，68岁。因大便变细及便血4月，加重1月入院。有冠心病史。查直肠距肛门7cm处，呈环状狭窄包块，固定，腔径＜1cm。诊断为直肠癌晚期、肠梗阻。行乙状结肠造瘘术后，造     

UniPron is A Fully Effective Non-hormonal Reversible Contraceptive in Baboon Model （Papio Anubis）

Objective To determine the safety and efficacy of UniPron as a reversible contraceptive.
Methods Vaginal swabs were obtained before and after UniPron administration, cultured onto appropriate culture media and bacteria identification was done based on type of media used, Gram stain reactions, colony morphology and biochemical tests. Vaginal biopsy tissues were processed using paraffin wax method, stained with hematoxylin and eosin and examined under light microscopy to determine the effect of the product on vaginal tissues. The effect of UniPron on sperm was examined by mixing the product with electroejaculated spermatozoa in vitro at different concentrations. For efficacy studies, male baboons of proven fertility were mated with UniPron treated or untreated females of proven fertility during the fertile stages.
Results All the five females （100%） that were treated with UniPron did not conceive and they regained total fertility when the treatment was stopped while all the controls conceived. At a concentration of 40%, UniPron completely immobilized spermatozoa in an in-vitro system. UniPron mechanism of action was by lowering the vaginal pH and on application in baboon, the pH was lowered for at least 3 h after which it went back to normal.
Conclusions As we plan for a study to test UniPron as a microbicide to prevent STIs including HIV, our current study has established that this novel product is effective in contraception and harmless to vaginal tissues and vaginal microbial flora in a baboon model （Papio anubis）.     

Evaluation of diuretic and laxative activity of hydro-alcoholic extract of Desmostachya bipinnata （L,） Stapf in rats

OBJECTIVE： In continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata （Linn） Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats. METHODS： The hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Sox- hlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide （20 mg/kg） was served as positive control for diuretic activity and sennosides （10 mg/kg） served as negative control for laxative activity. RESULTS： The hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide （P〈0.01）. Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration （Na＋, K＋, and Cl-） at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides. CONCLUSION： Altogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.     

Effect of the disruption of three cytoskeleton components on chondrocyte metabolism in rabbit knee cartilage

Background Chondrocytes＇ phenotype and biosynthesis of matrix are dependent on having an intact cytoskeletal structure.Microfilaments,microtubules,and intermediate filaments are three important components of the cytoskeletal structure of chondrocytes.The aims of this study were to determine and compare the effects of the disruption of these three cytoskeletal elements on the apoptosis and matrix synthesis by rabbit knee chondrocytes in vitro.Methods Chondrocytes were isolated from full-thickness knee cartilage of two-month-old rabbits using enzymatic methods （n=24）.The isolated cells were stabilized for three days and then exposed to low,medium,and high doses of chemical agents that disrupt the three principal cytoskeletal elements of interest：colchicine for microtubules,acrylamide for intermediate filaments,and cytochalasin D for actin microfilaments.A group of control cells were treated with carrier.Early apoptosis was assessed using the Annexin-FITC binding assay by flow cytometry on days 1 and 2 after exposure to the disrupting chemical agents.The components and distribution of the cytoskeleton within the cells were analyzed by laser scanning confocal microscopy （LSCM） with immunofluorescence staining on day 3.The mRNA levels of aggrecan （AGG） and type Ⅱ collagen （Col-2） and their levels in culture medium were analyzed using real-time PCR and enzymelinked immunosorbent serologic assay （ELISA） on days 3,6,and 9.Results In the initial drug-dose-response study,there was no significant difference in the vitality of cells treated with 0.1 μmol/L colchicine,2.5 mmol/L acrylamide,and 10 μg/L cytochalasin D for two days when compared with the control group of cells.The concentrations of colchicine and acrylamide treatment selected above significantly decreased the number of viable cells over the nine-day culture and disrupted significantly more cell nuclei.Real-time PCR and ELISA results showed that the mRNA levels and medium concentrations of AGG and Col-2 were significantly decreased for     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

Iloprost inhibits fracture repair in rats

Background Previous studies have shown that prostaglandins （PGs） dramatically stimulate healing processes in bone.However,the effect of prostaglandin l2 （PGI2） on fracture healing remains unclear.To investigate the effect of PGI2,a study on fracture healing process in closed tibia fractures was designed.Methods Thirty-six Sprague-Dawley male rats were randomized into two groups.On the first day,their right tibias were fractured by three-point bending technique.The study group （n=18） received a single injection of 10 μg/kg iloprost for 5 days,while the control group （n=18） received saline solution in the same way.On the 7th,14th and 28th days following the fracture,six rats were sacrificed and their right legs were harvested in each group.The progression of fracture healing was assessed for each specimen by the scores of radiography （by Lane-Sandhu） and histology （by Huo et al）.Results On the 7th day,the radiographic and histologic scores were equal.On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group,whereas radiographic total score was 11 and histologic total score was 33 in the control group.On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group （P 〈0.05）.On the 28th day radiographic total score was 12 and histologic total score was 37 in the iloprost group,whereas radiographic total score was 15 and histologic total score was 40 in the control group.On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group,it was not statistically significant （P 〉0.05）.Conclusion Iloprost delays fracture healing in early stage in rats.     

Effect of Shenfu on the Expression of Bcl-2 and Bax of Intestinal Mucosal Epithelial Cells after Ischemic Reperfusion in Rats

Objective To study the effect of Shenfu on the expression of bax and bcl-2 in small intestinal mucosal epithelial cells after ischemic reperfusion injury and explore the effect of Shenfu on small intestinal mucosal epithelial cells apoptosis. Methods 36 SD rats were randomized into three groups, each consisting of 12 rats： Sham group （S group）, Ischemic reperfusion group （IR group）, Shenfu group （SF group）, Ischemic reperfusion models were made by ligated the superior menseneric artery for 1 hour followed by 2 hrs reperfusion. Histological mucosal damage in each group was graded according to Chiu＇s score. Immunohistochemistry detected the expression of bax and bcl-2, and obtained the optical density （OD） value using a color image pattern analysis system, and then calculated the ratio of bcl-2/bax. TUNEL method measured apoptotic intestinal mucosal epithelial cells, and calculated the apoptotic index. Results There were edema and epithelial impairment in part of villus and the integral was higher in SF group than S group （P〈0.05）, but lower than IR group （P〈0.01）. Compared IR group with S group and SF group, the average OD value of bcl-2 and bax had significant statistic difference （P〈0.01）, and the average OD value of bcl-2 in SF group was higher than in S group （P〈0.05）, meanwhile bcl-2/bax was significantly lower in IR group than in S group and SF group （P〈0.01）, but that was higher in SF group than in S group （P〈0.05）. Apoptotic index in IR group was significantly higher than that in other two groups （P〈0.01）, and that in SF group was higher than in S group （P〈0.05）. Conclusion Shenfu can enhance the expression of bcl-2, decrease the expression of bax, meanwhile increase the ratio of bcl-2/bax, inhibit small intestinal mucosal epithetlial cells apoptosis, and protect small intestine mucosal epithetlial after ischemic reperfusion.     

补肾活血方对PCOS大鼠模型卵巢中PAI-1mRNA表达的影响

目的探讨补肾活血方对大鼠PCOS模型卵巢局部纤溶酶原激活物抑制因子-1（PAI—1mRNA）表达的影响。方法选用未成年24d龄SD雌性大鼠60只,随机分为模型组、克罗米酚组、补肾活血方高剂量组、补肾活血方低剂量组、正常对照组5组。用Bogovich法建立大鼠多囊卵巢病理模型。以克罗米酚为对照。用原位杂交法观察补肾活血方对多囊卵巢大鼠局部PAI—1mRNA的影响。结果模型组卵巢局部PAI—1mRNA存在卵泡膜间质细胞显著增高,用补肾活血方高、低剂量与克罗米酚药后,卵巢局部PAI-1mRNA的表达明显降低．差异具有统计学意义（P〈0．05、P〈0．01）。补肾活血方高剂量组与克罗米酚组比较,差异具有显著统计学意义（P〈0．01）;低荆量组与克罗米酚组比较差异无统计学意义（P〉0．05）,补肾活血方高、低剂量组比较,低剂量组卵泡膜间质细胞上PAI-1的基因表达增高更明显,但二者差异无统计学意义（P〉0．05）。结论PAI-1mRNA可能与多囊卵巢综合征的发病机制有关。以补肾活血立法的补肾活血方能降低多囊卵巢大鼠局部PAI—1mRNA的显著增高表达．降低PAI—1mRNA卵巢局部的作用。提示补肾活血方可能通过PAI—1mRNA途径促进卵巢排卵的机制。     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

The Targeted Pro-apoptotic Effect of scFv-mediated Delivery of Caspase-6 on HER2-positive Osteosarcoma Cells

Objective To investigate the pro-apoptotic effect of scFv-mediated delivery of caspase-6 fusion protein on osteosarcoma E 10 cells. Methods The expression of human epidermal growth factor receptor-2 （Her-2） in osteosarcoma cell line E10 was examined by flow cytometry analysis. ScFv-mediated delivery of caspase-6 was generated by sequential fusion of the genes of a signal peptide, a single-chain Her-2 antibody （e23sFv）, a PEA translocation domain （PEA aa253-264）, and an recombinant caspase-6. The pCMV-immunocaspase-6 was produced by cloning above mentioned fusion genes into pCMV plasmid, and then pCMV-immunocaspase-6 plasmid mixed cationic liposome was transfected into E10 cells. The expression of fusion gene on transfected E10 cells was detected by immunocytochemical staining, The pro-apoptotic effects of fusion gene expression on morphology and growth status of E10 cells were observed by trypan blue cell staining, electron microscopy and MTT assay. Results The fusion protein was detected in the cytoplasm of the transfected E10 cells. These cells presented typical characteristics of apoptosis as detected by electron microscopy. MTT assay revealed that the proliferation of transfected E10 cells was suppressed than that of non- or mock-transfected cells （P〈0.01）. Conclusion ScFv-mediated delivery of caspase-6 fusion protein can induce apoptosis of Her-2 positive osteosarcoma E10 cells, suggesting the potential of this strategy for the treatment of human high-grade osteosarcoma.